potter and perry chapter 27 patient safety

The QSEN safety competency for a nurse is defined as:

"Minimizies risks of harm to patients and provides through both system effectiveness and individual performance"

What are some nursing assessment questions for history of falls?

Have you ever fallen or tripped over anything in your home? Have you ever suffered an injury from a fall? What was it and how did it happen? did you have any symptoms right before you fell? What were they? Which activity were you performing before the fall?

patient safety goals from the TJC to reduce medical errors

Identify patients correctly Use 2 identifiers Improve staff communication Report test results in a timely manner Bedside report Use medicines safely Label all medications Reduce harm related to anticoagulant therapy Use alarms safely Prevent Infection Use good hand hygiene Prevent MRSA Prevent central catheter associated infection Prevent mistakes in surgery o Safe practices related to surgical site

Fire Prevention

Know the number for reporting fires. Should be visible on the phone at all times. Know the fire drill and evacuation plan of the agency Know the location of all fire alarms, exits, extinguishers, and oxygen shut off in your work area

standardized wristbands

Red-allergies Yellow-falls Purple-DNR Pink- limb alert Green- latex allergy

R>A>C>E (fire safety)

Remove/ Rescue; Alarm; Contain/Confine; Extinguish

6 patient rights

Right route right drug right dose right patient right frequency right documentation

Nursing Process-Diagnosis Some possible NANDA nursing diagnoses include:

Risk for Injury Risk for Falls Risk for Poisoning Risk for Aspiration Risk for Trauma

Nursing diagnosis for patients with safety risks

Risk for falls impaired home maintenance risk for injury deficient knowledge risk for poisoning risk for suffocation risk for trauma

freedom from psychological and physical injury, and is a basic human need

Safety

What are some nusing assessment questions for Medication history?

Which medications (prescription, over the counter, herbal) do you take? Has your doctor or pharmacist reviewed your medicines with you? Do any medications make you dizzy or light headed?

What are some nursing assessment questions for home maintenance and safety?

Whoe does your simple home maintenance or minor home repairs? Who shovels your snow? Tends to your lawn? Do you feel safe in your home? Which things in your environment make you feel unsafe? Do you have someone to call in case of an emergency? How do you feel aout modiying your home to make if safer? Do you need help finding resources to help you do this?

incident report

a confidential document that completely describes any patient accident occurring on the premises of a health care agency.

Patient-inherent accidents

accidents (other than falls) in which a patient is the primary reason for the accident self inflicted injuries

nursing assessment questions for safety

activity and execrise: do you use any assistive devices such as a wheelchair, walker, or cane to help you move or get around? did someone show you how to use them safely? *do you have any difficulty bathing? dressing?eating? using the bathroom?transferring out of the bed or chair?

A patients environment includes what?

all of the many physical and psychosocial factors that influence or affect the life and survival of that patient.

When an adverse event occurs the nurse fills out_________________

an incident report

Restraint

any manual method, physical, or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs body or head freely.

pathogen

any microorganism capable of producing an illness

active immunity

by an injection of a small amount of attenuated or dead organisms into the body

MSDS book provides what kind of information

detailed information about the chemical, health hazards imposed, first aid guidelines and precautions for safe handling and use

Among adults age 64 and older what is the leading cause of unintentional injuries?

falls

specific risks to patients safety in health care setting

falls, patient inherent accidents, procedure related accidents and equipment related accidents

what is the most common means of transmission of pathogens?

hands

what is the leading cause of death and injury in school aged children?

head injuries, with bicycle accidents being one of the major causes of such injuries

What does a fall assessment tool do? and when is it done?

helps you assess important risk factors, needs to be completed on admission or following a change in the patients condition

Reduces the , and in some cases prevents, the transmission of disease from person to person

immunization

Active strategies include

in which the individual is actively involved through changes in lifestyle (wearing seat belts, installing outdoor lighting)

What groups require help in achieving a safe environment?

infants children older adults physically and mentally disabled the illiterate the poor

In care of safety the nurse

integrates knowledge from nursing and other scientific disciplines, previous experiences in caring for patients who had an injury or were at risk, critical thinking attitudes such as responsibility and discipline and any standards of practice that are applicable.

What are the individual risk factors for safety?

lifestyle-operating machinery or driving while under the influence, stress, fatigue, anxiety sensory or communication impairment: delirium, dementia, and depression place patients at risk for injury, become easily confused about their surrounding lack of safety awareness-not paying attention to expiration dates of food or medication

these happen when something that was planned as part of medical care but doesn't workout or when the wrong plan was used.

medical errors

What does a safe environment mean?

meeting basic needs, reducing physical hazards, and the transmission of pathogens and controlling pollution

According to Maslow's hierarchy of needs these basic needs ___________ before physical and psychological safety and security can be addressed.

must be met

What are basic needs?

need for sufficient oxygen nutrition optimum temperature

Risk for injury-assessment activities

observe patients posture, rom, strength, balance, and body alignment ask about patients visual acuity complete a home hazard appraisal

passive immunity

occurs when antibodies produced by other person or animals are introduced into a persons blood stream for protections

Hypothermia

occurs when the core body temperature drops to 95 degrees or lower

Which groups are at high risk for hypothermia?

older adults, children and infants patients with cardiovascular conditions patients who have ingested drug or alcohol in excess people who are home less

Alternatives to restraints

orient patients and families to environment; explain all procedures provide companionship and supervision offer diversion activities-music assign confused patients near nurses station provide appropriate visual and auditory stimuli remove things that promote leaving promote relaxation techniques and normal sleep patterns institute exercise and ambulation schedules frequent toileting, food and liquid camouflage iv lines with clothing, stockineete or kling dressing Evaluate all meds and ensure effective pain management reassess physical status and review lab findings

patient inherent accident

patient is primary reason for the accident

Any substance that impairs health or destroys life when ingested, inhaled, or absorbed through the body

poison

what are the factors that increase the risk for fall in older adults 65 and older?

reduced vision, orthostatic hypotension, lower-extremity weakness, gait and balance problems, urinary incontinence, improper use of walking aid, and the effect of various medications.

The use of __________ must be clinically justified. Need a doctors ___________ for restraints.

restraints, order

The _______ campaign encourages patients to take a role in preventing health care errors by becoming active, involved, and informed participants on the health care team.

speak up

How do nurses participate in health promotion?

supporting legislation acting as positive role models working in community based settings

success critical thinking requires

synthesis of knowledge, experience, information gathered from patients, critical thinking attitudes, and intellectual and professional standards

What part of the vehicle is the safest in the event of a crash and prevents injury from deployment of passenger and side air bags?

the back seat

Why was the quality and safety education for nurses project developed? QSEN

to meet the challenge of preparing future nurses who will have the knowledge skill and attitudes necessary to continuously improve the quality and safety of the health care system within which they work.

What does a safe environment do?

*reduces the risk for illness and injury *helps to contain the cost of health care by preventing extended lengths of treatment and or hospitalizations *improving or maintaining a patients functional status *increasing the patients sense of well being

How do health care organizations foster a patient centered safety culture?

1. continually focusing on performance improvement endeavors 2. risk management findings 3. safety reports providing current reliable technology 4. intergrating evidence based practice into procedures 5. designing a safe work environment 6. providing continuing education 7. access to appropriate resources for staff

What type of things are asked in a fall risk assessment too?

Age of patient fall history Elimination-incontinent, urgency Meidcations-anticonvulsants, antihypertensives, diuretics, hypnotics, laxatives, sedatives, and psychotrophics patient care environment: iv, chest tube, indwelling catheters mobility cognition

what kind of safety alarms can we use to keep patients safe

Bed alarms heart monitors telemetry breathing monitor

Fall prevention

Signage Wrist bands Socks Instruction Hourly rounding Items in reach Call for assistance

The correct placement of an infant car seat in the vehicle is:

The car seat should be rear-facing in the back seat

What is the best resource when parents and patients need information about the treatment of accidental poisoning?

The poison control center